Valley Lodge Care Home

The care home is an adapted and extended property which has recently been zoned to provide two main accommodation areas, each with access to an outside space. There are also two separate isolation areas.

People’s experience of using this service and what we found

People were not always safe. We found there were improvements needed to water hygiene risk management.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive ways possible, or in their best interests; the policies and systems in the service did not support this practice. This was a continued area of concern from the last inspection.

We made a recommendation about medicines as we were concerned at how they were being managed.

Risks associated with people and the environment were thoroughly assessed and there were extensive security measures including key pad entry systems and extensive CCTV coverage.

Staff were safely recruited and most people’s feedback told us there were sufficient staff deployed.

Infection prevention and control was very good and the home had been adapted to facilitate safe management of infection should there be cases of Covid-19.

Staff had a working knowledge of the MCA and ensured people were offered choices.

Assessments are care plans were completed and care plans were displayed on the e-care system so staff could refresh themselves each time they undertook a care task.

Staff had received both formal and informal supervision, particularly during the pandemic. There had also been counselling provided should staff wish to participate.

Face to face staff training had been temporarily suspended during the pandemic. Alternatives such as workbooks and online learning had replaced some courses to ensure staff maintained their knowledge.

Most relatives were happy with the dietary and fluid support provided however we had one specific concern that a family member had lost significant weight and this had not been properly dealt with.

Healthcare professionals were available as required. Additional safety measures such as using full PPE were in place to facilitate their access to the service.

The service was well designed and had specific areas designed for reminiscence to enhance the lives of people living with dementia.

People were supported to live fulfilling lives.

The provider was aware of their responsibilities under the duty of candour. Relatives felt that communication could be improved.

The nominated individual was very supportive to the registered manager and there was a management team in place who oversaw particular areas of the service. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

Care staff told us that support from the management team was good and they were approachable.

We received mixed feedback from health and social care professionals about how engaged the provider was with them.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 5 January 2019). The service remains rated requires improvement.

At our last inspection, the provider was in breach of Regulation 11 of the Health and Social Care Act, Regulated Activities Regulations 2014, need for consent. At this inspection we found, although some improvements had been made, there were almost half of the inspected consent documents either not signed by someone with legal authority to do so or not signed. Not enough improvement had been made or sustained and the provider was still in breach of regulations. We found that the provider was also in breach of Regulation 12 of the Health and Social Care Act, Regulated Activities Regulations 2014, safe care and treatment.

Why we inspected

We carried out an unannounced, comprehensive inspection of this service on 23 October 2018. A breach of legal requirements was found. We undertook this focused inspection to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Valley Lodge on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to Regulation 12, safe care and treatment as the provider did not have a suitable water hygiene risk assessment, and a continuing breach of Regulation 11, the need for consent. This related to consents obtained for use of CCTV and photographs.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

As a result of this inspection we have made one requirement. This is where we have identified a statutory breach of regulations. The breach in regulation requires the provider to make sure the service complies with legislation designed to protect people’s rights, in this case the requirements of the Mental Capacity Act 2005.

Valley Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service provides accommodation and personal care and support to a maximum of 47 older people, including those who are living with dementia, in one adapted building. There were 31 people using the service at the time of our inspection.

The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; however, the policies and systems in the service had not always supported this practice and legislation designed to protect people’s rights had not been followed.

There was a friendly atmosphere in the home and staff supported people in a kind and caring way that took account of their individual needs and preferences.

There were systems and processes in place to protect people from harm. Staff were trained in how to recognise and respond to abuse and understood their responsibility to report any concerns. Risks to people were individually assessed and action taken to minimise the likelihood of harm.

There were suitable systems in place to ensure the safe storage and administration of medicines. Medicines were administered by staff who had received appropriate training.

Safe recruitment practices were followed and appropriate checks had been undertaken, which made sure only suitable staff were employed to care for people in the home. There were sufficient numbers of experienced staff to meet people’s needs.

Staff received an induction and on-going training to support them to meet the needs of people using the service.

People received regular and on-going health checks and support to attend appointments. They were supported to eat and drink enough to meet their needs and to make informed choices about what they ate.

The service was responsive to people’s needs and staff listened to what they said. Staff were prompt to raise issues about people’s health and people were referred to health professionals when needed. People could be confident that any concerns or complaints they raised would be dealt with.

The provider and registered manager were promoting an open, empowering and inclusive culture within the service. There were a range of systems in place to assess and monitor the quality and safety of the service.

We found that the service assessed, planned and delivered care for people with dementia in a considered and responsive way. They cooperated effectively with other providers to ensure that the safety and welfare of people was protected when their health care needs changed or when they moved between different services. The service was well led and continually assessed the quality of the care provided.

We observed that staff promoted an inclusive and supportive environment. A person living in the home told us 'The care staff always make time to talk to me. There was something I was worried about; the staff told me they are here to help'. Another person said 'The main thing is I feel safe here; they have taken away the worry from me'. A visitor remarked 'This is a lovely home and the staff have so much patience and respect for the residents'.

People were, as far as they were able to do so, involved in making decisions about their care and support.

People's needs were continually assessed and care was delivered in line with their care plans. There were policies and procedures in place to ensure that the safety and suitability of the premises was maintained, these were understood and followed by staff.

Staff were well supported by management and were provided with appropriate training to help them understand and meet the needs of the people who use the service.

There was an effective system in place to deal appropriately with comments and complaints made by people, or persons acting on their behalf. People living at the home had been given information about procedures to make comments and complaints and staff were trained to listen and act appropriately.